California Safety-Net Hospitals Likely To Be Penalized By ACA Value, Readmission, And Meaningful-Use Programs
California Safety-Net Hospitals Likely To Be Penalized By ACA Value, Readmission, And Meaningful-Use Programs
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DOI：
10.1377/hlthaff.2014.0138
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发表时间：
2014-08-01
期刊：
影响因子：
9.7
通讯作者：
Becker, Edmund R.
中科院分区：
文献类型：
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作者：
Gilman, Matlin;Adams, E. Kathleen;Becker, Edmund R.
《平价医疗法案》包括增加医疗保健支出价值的条款。卫生政策专家越来越担心的是，旨在提高医院护理质量和效率的新医疗保险政策，如基于价值的采购（VBP），医院再入院减少计划（HRRP）和电子健康记录（EHR）有意义的使用标准，将不成比例地影响安全网医院，在医疗保险和医疗补助制度下，这些医院已经面临着减少的医疗费用份额（DSH）。我们调查了加州的医院，以确定安全网机构是否比其他机构更有可能在这些计划下受到惩罚。为了评估质量，我们还检查了这些医院的死亡率结果是否不同。我们的研究发现，与非安全网医院相比，安全网机构在2009- 2011年期间急性心肌梗死、心力衰竭和肺炎的30天风险调整死亡率较低，调整后的医疗保险成本也略低。尽管如此，安全网医院比其他医院更有可能受到VBP计划和HRRP的惩罚，更有可能不符合EHR有意义的使用标准。随着国家政策制定者进一步将绩效指标纳入整体支付体系，需要考虑医疗保险基于价值的支付政策对安全网医院财务可行性的综合影响沿着DSH支付削减。
The Affordable Care Act includes provisions to increase the value obtained from health care spending. A growing concern among health policy experts is that new Medicare policies designed to improve the quality and efficiency of hospital care, such as value-based purchasing (VBP), the Hospital Readmissions Reduction Program (HRRP), and electronic health record (EHR) meaningful-use criteria, will disproportionately affect safety-net hospitals, which are already facing reduced disproportionate-share hospital (DSH) payments under both Medicare and Medicaid. We examined hospitals in California to determine whether safety-net institutions were more likely than others to incur penalties under these programs. To assess quality, we also examined whether mortality outcomes were different at these hospitals. Our study found that compared to non-safety-net hospitals, safety-net institutions had lower thirty-day risk-adjusted mortality rates in the period 2009-11 for acute myocardial infarction, heart failure, and pneumonia and marginally lower adjusted Medicare costs. Nonetheless, safety-net hospitals were more likely than others to be penalized under the VBP program and the HRRP and more likely not to meet EHR meaningful-use criteria. The combined effects of Medicare value-based payment policies on the financial viability of safety-net hospitals need to be considered along with DSH payment cuts as national policy makers further incorporate performance measures into the overall payment system.